ECG-based Predictors of Re-infarction or Death on the Hospital Admission 12-Lead ECG among UA/NSTEMI Patients: A Protocol for a Systematic Review and Meta-Analysis

Abstract

Background The incidence of unstable angina/ non-ST elevation MI (UA/NSTEMI) continues to rise. The electrocardiogram (ECG) remains the first-line assessment of cardiac conduction and myocardial ischemia, and is performed within the first 10-minutes of hospital presentation. Despite recent advances in treatment, in-hospital death and re-infarction continues as a result of delayed interventions. Since the ECG is a rapid test to guide treatment decisions, it is crucial emergency providers understand the prognostic value of characteristics on the admission 12-lead ECG to decide treatments which may reduce the risk of re-infarction and death. This is the first systematic review and meta-analysis to assess the significance of these ECG findings associated with in-hospital death and re-infarction. Methods A systematic review and meta-analysis will be conducted to comprehensively assess the prognostic value of specific characteristics on the admission 12-lead ECG associated with re-infarction and death. This is the protocol for such review and meta-analysis. Electronic databases and specific cardiovascular journals will be searched using predefined search terms to identify relevant studies. Eligible studies will be peer-reviewed research articles with empirical findings on the risk re-infarction and death based on characteristics on the admission 12-lead ECG. The methodological quality of the included studies will be assessed with the Newcastle-Ottawa Quality Assessment Scale and GRADE. Citations will be managed using EndNote X9. A random effects meta-analysis will be conducted with the Meta-Essentials package and STATA. Discussion This study will be among the first to systematically evaluate and quantitatively assess the evidence available on the prognostic value of characteristics on the admission 12-lead ECG for the risk of re-infarction and death. This study will inform clinicians about the significance of characteristics on the admission 12-lead ECG so better treatment decisions can be made, as well as inform new research opportunities in the field of cardiovascular risk stratification. Registration This systematic review and meta-analysis is registered with the International Prospective Register of Systematic Reviews (PROSPERO; ID CRD42020158491).